6.3.3 Headache attributed to dural arteriovenous fistula (DAVF)

Identification: Female patient, 58 years old, with no known comorbidities, reports progressive chronic headache for 3 months. History of Present Illness: Headache: Right occipital pulsatile location (intensity 6-8/10). Aggravated by: Postural changes (orthostatic), Valsalva maneuvers (coughing, straining). Associated with: Ipsilateral pulsatile tinnitus (synchronous with pulse), Episodes of transient blurred vision. No history of head trauma or recent infections. Neurological Examination: Cranial auscultation: Systolic bruit over right mastoid region. Focal signs: Absent (NIHSS = 0). Fundoscopy: Mild bilateral papilledema (Frisen grade 1). Blood pressure: 130/80 mmHg. Complementary Exams: Non-contrast cranial CT: Right temporal cortical venous dilation, No hemorrhagic or ischemic lesions. MR angiography/CT angiography: Dural arteriovenous fistula (DAVF) Borden type I/Cognard type IIa, Location: Right transverse sinus, Fistula fed by branches of the external occipital and meningeal arteries. Cerebral angiography (gold standard): Early arterialized flow in the right transverse sinus, Cortical venous drainage without reflux.